CNS - Cholinomimetics - direct acting - Indirect acting

12 important questions on CNS - Cholinomimetics - direct acting - Indirect acting

What are the therapeutic uses of Neostigmine?

Neostigmine is used for:
  • Myasthenia gravis
  • Urinary retention
  • Antidote to NMB's
  • Postoperative ileus
  • Atonic constipation
  • Paroxysmal supraventricular tachycardia

What are some examples of organophosphate compounds used as pesticides?

Examples include:
  • Dichlorvos (Doom/Boom)
  • Di-isopropylflourophosphate
  • Echothiophate
  • Malathion
  • Parathione

What is the dosage for Neostigmine in treating Myasthenia gravis?

Dosage for Myasthenia gravis: 15–375 mg/day PO; 0.5–1mg IM, SC every 4–6hrs PRN.
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What do indirectly acting cholinomimetics do to AChE in the cholinergic synapse?

They irreversibly phosphorylate and inhibit AChE from hydrolysing ACh in the cholinergic synapse, resulting in continued amplification of ACh effects-toxicity.

Which organophosphate compound is not highly lipid soluble and cannot cross the blood-brain barrier?

Echothiophate is not highly lipid soluble and cannot cross the blood-brain barrier. Other compounds like Dichlorvos, Malathion, Metrifonate, and Parathion can.

What are the adverse effects of Neostigmine?

Adverse effects include:
  • Cardiac arrhythmias
  • Muscle fasciculation & paralysis
  • Nausea, vomiting, diarrhea
  • Salivation, bronchospasm
  • Urinary frequency, sweating

What are the therapeutic uses of Physostigmine?

Physostigmine is used for:
  • Glaucoma (0.25-0.5% topical solution)
  • Alzheimer’s disease (adjuvant)
  • Anti-muscarinic & TCA drug poisoning

What is the dosage for Physostigmine in treating Glaucoma?

Dosage for Glaucoma: 1–2 drops up to 3 times/day.

What are the adverse effects of Physostigmine?

Adverse effects include:
  • Lacrimation, headache
  • Allergic follicular conjunctivitis
  • Vomiting, diarrhea, salivation
  • Bronchospasm
  • CNS excitation, convulsions

What is the therapeutic use of Pyridostigmine?

Pyridostigmine is used for Myasthenia gravis.

What is the average dosage for Pyridostigmine?

Average dosage: 600 mg/day PO at intervals; Range: 60–1500mg/day.

What are the adverse effects of Pyridostigmine?

Adverse effects include:
  • Bronchial secretions
  • Bronchospasm
  • Cardiac arrhythmias
  • Muscle weakness

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